Browsing by Author "Musinguzi, Laban K."

Now showing 1 - 6 of 6
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    The Female Genital Mutilation Economy and the Rights of the Girl Child in Northeastern Uganda
    (Springer, Cham, 2017) Ochen, Eric A.; Musinguzi, Laban K.; Nanfuka Kalule, Esther; Ssemakula, Eugene G.; Kukundakwe, Rebecca; Opesen, Chris C.; Bukuluki, Paul
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    The first mile: community experience of outbreak control during an Ebola outbreak in Luwero District, Uganda
    (BMC public health, 2016) de Vries, Daniel H.; Rwemisisi, Jude T.; Musinguzi, Laban K.; Turinawe, Benoni E.; Muhangi, Denis; de Groot, Marije; Kaawa-Mafigiri, David; Pool, Robert
    A major challenge to outbreak control lies in early detection of viral haemorrhagic fevers (VHFs) in local community contexts during the critical initial stages of an epidemic, when risk of spreading is its highest (“the first mile”). In this paper we document how a major Ebola outbreak control effort in central Uganda in 2012 was experienced from the perspective of the community. We ask to what extent thecommunity became a resource for early detection, and identify problems encountered with community health worker and social mobilization strategies. Methods: Analysis is based on first-hand ethnographic data from the center of a small Ebola outbreak in Luwero Country, Uganda, in 2012. Three of this paper’s authors were engaged in an 18 month period of fieldwork on community health resources when the outbreak occurred. In total, 13 respondents from the outbreak site were interviewed, along with 21 key informants and 61 focus group respondents from nearby Kaguugo Parish. All informants were chosen through non-probability sampling sampling. Results: Our data illustrate the lack of credibility, from an emic perspective, of biomedical explanations which ignore local understandings. These explanations were undermined by an insensitivity to local culture, a mismatch between information circulated and the local interpretative framework, and the inability of the emergency response team to take the time needed to listen and empathize with community needs. Stigmatization of the local community – in particular its belief in amayembe spirits – fuelled historical distrust of the external health system and engendered community-level resistance to early detection. Conclusions: Given the available anthropological knowledge of a previous outbreak in Northern Uganda, it is surprising that so little serious effort was made this time round to take local sensibilities and culture into account. The “first mile” problem is not only a question of using local resources for early detection, but also of making use of the contextual cultural knowledge that has already been collected and is readily available. Despite remarkable technological innovations, outbreak control remains contingent upon human interaction and openness to cultural difference.
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    The role of social networks in savings groups: insights from village savings and loan associations in Luwero, Uganda
    (Community Development Journal, 2016) Musinguzi, Laban K.
    Studies of village savings and loan association (VSLAs) programmes in several African countries portray these initiatives as spaces that increase financial access for the poor, improve livelihoods, and provide members with social capital. Little is known, however, about their impact beyond increasing financial access. This paper shows that the benefits that accrue (or do not) from membership in VSLAs are mediated through networks of friendships and other social relations that predate the introduction of VSLAs. Based on ethnographic research on VSLAs conducted between 2012 and 2014 in Luwero District, Uganda, this paper examines women’s experiences in VSLAs, how social networks influence their decision to join a VSLA, and how VSLAs provide women an opportunity to exercise agency through utilizing their social networks in their community. In this way, they are able to challenge structural barriers to financial autonomy and control at the household level.
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    Selection and Performance of Village Health Teams (VHTS) in Uganda: Lessons from the Natural Helper Model of Health Promotion
    (Human resources for health, 2015) Turinawe, Emmanueil Benon; Rwemisisi, Jude T.; Musinguzi, Laban K.; Groot, Marije de; Muhangi, Denis; Vries, Daniel H. de; Mafigiri, David K.; Pool, Robert
    Community health worker (CHW) programmes have received much attention since the 1978 Declaration of Alma-Ata, with many initiatives established in developing countries. However, CHW programmes often suffer high attrition once the initial enthusiasm of volunteers wanes. In 2002, Uganda began implementing a national CHW programme called the village health teams (VHTs), but their performance has been poor in many communities. It is argued that poor community involvement in the selection of the CHWs affects their embeddedness in communities and success. The question of how selection can be implemented creatively to sustain CHW programmes has not been sufficiently explored. In this paper, our aim was to examine the process of the introduction of the VHT strategy in one rural community, including the selection of VHT members and how these processes may have influenced their work in relation to the ideals of the natural helper model of health promotion.As part of a broader research project, an ethnographic study was carried out in Luwero district. Data collection involved participant observation, 12 focus group discussions (FGDs), 14 in-depth interviews with community members and members of the VHTs and four key informant interviews. Interviews and FGD were recorded, transcribed and coded in NVivo. Emerging themes were further explored and developed using text query searches. Interpretations were confirmed by comparison with findings of other team members.The VHT selection process created distrust, damaging the programme’s legitimacy. While the Luwero community initially had high expectations of the programme, local leaders selected VHTs in a way that sidelined the majority of the community’s members. Community members questioned the credentials of those who were selected, not seeing the VHTs as those to whom they would go to for help and support. Resentment grew, and as a result, the ways in which the VHTs operated alienated them further from the community. Without the support of the community, the VHTs soon lost morale and stopped their work.As the natural helper model recommends, in order for CHW programmes to gain and maintain community support, it is necessary to utilize naturally existing informal helping networks by drawing on volunteers already trusted by the people being served. That way, the community will be more inclined to trust the advice of volunteers and offer them support in return, increasing the likelihood of the sustainability of their service in the community.
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    Towards Promotion of Community rewards to Volunteer Community Health Workers? Lessons from Experiences of Village Health Teams in Luwero, Uganda
    (Res Health Sci,, 2016) Turinawe, Emmanueil Benon; Rwemisisi, Jude T.; Musinguzi, Laban K.; Groot, Marije de; Muhangi, Denis; Mafigiri, David K.; Vries, Daniel H. de; Pool, Robert
    In the debate regarding volunteer Community Health Workers (CHWs) some argue that lack of remuneration is exploitation while others caution that any promise to pay volunteers will decrease the volunteer spirit. In this paper we discuss the possibility of community rewards for CHWs. Ethnographic fieldwork that lasted 18 months utilised methods including participant observation, FGDs, in-depth interviews and key informant interviews to gain insight into the dynamic relationship between volunteer CHWs known as Village Health Teams (VHTs) and the community. Contextual transcription was done and data was thematically analysed. Findings show that community members are willing to reward volunteer CHWs with cash, material and symbolic rewards in appreciation for their help. Factors crucial for this gesture included: care and recognition of the VHTs’ work by medical staff, fulfilment of the promises made to the community by government and exemplary behaviour by CHWs. Therefore, effort should be made to facilitate volunteer CHWs to be seen as helpful to their communities. Especially, there needs to be a smooth operation at the intersection between the VHTs, local government and medical structures. Community rewards could be a more sustainable way of motivating CHWs while a solution to health personnel shortage is sought.
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    Traditional Birth Attendants (TBAS) as Potential Agents in Promoting Male Involvement in Maternity Preparedness: Insights from a Rural Community in Uganda
    (Reproductive health, 2016) Turinawe, Emmanueil Benon; Rwemisisi, Jude T.; Musinguzi, Laban K.; Groot, Marije de; Muhangi, Denis; Vries, Daniel H. de; Mafigiri, David K.; Katamba, Achilles; Parker, Nadine; Pool, Robert
    Since the 1994 International Conference on Population and Development, male involvement in reproductive health issues has been advocated as a means to improve maternal and child health outcomes, but to date, health providers have failed to achieve successful male involvement in pregnancy care especially in rural and remote areas where majority of the underserved populations live. In an effort to enhance community participation in maternity care, TBAs were trained and equipped to ensure better care and quick referral. In 1997, after the advent of the World Health Organization’s Safe Motherhood initiative, the enthusiasm turned away from traditional birth attendants (TBAs). However, in many developing countries, and especially in rural areas, TBAs continue to play a significant role. This study explored the interaction between men and TBAs in shaping maternal healthcare in a rural Ugandan context.This study employed ethnographic methods including participant observation, which took place in the process of everyday life activities of the respondents within the community; 12 focus group discussions, and 12 in-depth interviews with community members and key informants. Participants in this study were purposively selected to include TBAs, men, opinion leaders like village chairmen, and other key informants who had knowledge about the configuration of maternity services in the community. Data analysis was done inductively through an iterative process in which transcribed data was read to identify themes and codes were assigned to those themes.Contrary to the thinking that TBA services are utilized by women only, we found that men actively seek the services of TBAs and utilize them for their wives’ healthcare within the community. TBAs in turn sensitize men using both cultural and biomedical health knowledge, and become allies with women in influencing men to provide resources needed for maternity care.In this study area, men trust and have confidence in TBAs; closer collaboration with TBAs may provide a suitable platform through which communities can be sensitized and men actively brought on board in promoting maternal health services for women in rural communities.